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Miscellaneous License/Registration


Form - COMMON SERVICE CENTRE(CSC) REGISTRATION

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Total Expenses : Rs 11800/-

Sponsor Present ? * Yes No




[ After Click On Primary Submit Check your Email ID for Final Submission ]

CSC NAME

VID No
Aadhaar No *
CSC Name *
Applicant Name *
As per mentioned on Aadhaar Card
Gender * Male Female
Date of Birth *
As per Aadhaar Card. (DD/MM/YYYY)
Applicant Photo *
JPG Format, Within 10KB Size
Mobile Number(1) *
Mobile Number(2) *
Email ID *

RESIDENTAIL DETAILS

Residential Type * Rural Urban
State *
District *
Sub District *
Gram Panchayat Name / Word No
Villege/Town/City *
Street *
Police Station *
Post Office *
Pin No *

KIOSK ADDRESS DETAILS

Same as Residental Address ? *
(If Yes, Don't fill Kiosk Address Details) 		Yes No
Location Rural Urban
State
District
Sub District
Gram Panchayat Name/ Word No
Villege/Town/City
Street
Police Station
Post Office
Pin No

BANK DETAILS

Bank Name *
Branch Name *
Account Holder Name *
Account Number *
IFSC Code *
Type of Account * Savings Current
Pan Type *
Pan Number *

DOCUMENTS REQUIRED

Applicant Aadhar Card *
JPG Format, 40 to 80 KB SIZE
Applicant Pan Card *
JPG Format, 30 to 50 KB Size
Applicant Passport Photo *
JPG FORMAT, Maximum 10 KB Size
Applicant Cancel cheque *
JPG Format, 30 to 50 KB Size
Applicant Voter ID/Identity Proof
JPG Format, 40 to 80 KB Size
Centre Out Side Photo *
Must be Geo Tag, Through Android Mobile, JPG Format, Maximum 50 KB Size.
Centre Inside Photo *
Must be Geo Tag, Through Android Mobile, JPG Format, Maximum 50 KB Size.
Applicant Highest Qualification Certificate *
JPG Format, 40 to 80 KB Size

Our Team

ARPITA CHAKRABORTY BANERJEE
IT Co Ordinator
Chhanda Barik
Mobilizer
ANINDITA ROY
IT Co Ordinator
Jharna Mallick
Caustomer Care Executive
DEBIKA SUBBA
IT Co-Ordinator
Kiran Bala Dey
Caustomer Care Executive
PRIYA BISWAKARMA
IT Co Ordinator
Nisha Sarki
Relationship Manager
Gopal Bera
CEO
Mousumi Pal
Tele Caller

Contact Info

Visit Us

At-Peerbaba Tower,1st Floor, OT Road, P.O-Inda,P.S-Kharagpur Town, Dist-Paschim Medinipur, State-West Bengal,Pin- 721305

Mail Us

ashadippsc@gmail.com
ashadippublicservicecentre@gmail.com

Call Us

+91 8918726833

Feel free to write your query


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